Physical disability

Disease Description (Causes and Symptoms)

• Definition: Physical disability is a condition in which the motor, sensory, or structural functions of the limbs and trunk are permanently limited due to congenital or acquired abnormalities of the nervous or musculoskeletal systems. Major categories include amputation disability (amputation of a limb), joint disability (limited range of motion or deformity), and physical-function disability (neurogenic muscle weakness, such as from spinal cord injury).
• Major causes
  • Congenital: Genetic abnormalities, chromosomal abnormalities, fetal infections (such as rubella), exposure to medications or radiation during pregnancy, difficult labor, etc.
  • Acquired: Trauma (traffic accidents, industrial accidents), spinal cord injury, cerebral palsy or brain injury, infection or inflammation, degenerative joint disease, chronic diseases (such as diabetic complications)
• Pathophysiology (summary): Structural defects of the skeleton or joints, or loss of muscle or nerve function, leads to loss of motor units, reduced muscle strength, impaired proprioception and sensation, joint contractures, and deformities, resulting in reduced mobility and independence.
• Major symptoms
  • Difficulty walking and moving (inability to walk, limping, need for assistive devices)
  • Muscle weakness or paralysis, abnormal muscle tone (spasticity or flaccidity)
  • Reduced joint range of motion and deformities (such as scoliosis)
  • Pain in the residual limb or neuropathic pain, reduced sensation
  • Limitations in daily activities due to reduced function, psychosocial problems (depression, reduced self-esteem)

Treatment Methods

• Treatment goals: Maintaining and improving function, controlling pain, preventing complications (such as pressure sores and joint contractures), and social rehabilitation (orthoses, walking skills, occupational therapy)
• Nonsurgical treatment
  • Rehabilitation therapy: Physical therapy (strengthening, balance training), occupational therapy (adaptation to activities of daily living and training in the use of assistive devices)
  • Assistive devices: Wheelchairs, walkers and canes, orthoses, custom-made prosthetic hands and legs
  • Drug treatment (according to symptoms): Analgesics, medications for neuropathic pain (such as gabapentin, pregabalin, and duloxetine), anticonvulsants and muscle relaxants (to control spasticity), anti-inflammatory drugs
  • Conservative management: Weight control, walking assistance and improvement of the home environment, skin care (pressure sore prevention), regular joint care
• Interventional/surgical treatment
  • Orthopedic surgery: Joint replacement (for severe joint damage), joint fusion, muscle or tendon surgery to prevent contractures, orthopedic treatment of the residual limb
  • Neurosurgery: Spinal cord decompression and fusion (for spinal lesions), nerve decompression, etc.
  • Fitting and rehabilitation with prosthetic hands and legs (custom fabrication and periodic adjustment)
  • Botulinum toxin (for relieving localized spasticity), spinal cord stimulators, and other options may be considered to relieve pain and spasticity
• Precautions (self-care)
  • Frequently check the skin condition of wounds, the residual limb, and pressure-bearing areas (to prevent pressure sores)
  • Use appropriate assistive devices and have them checked regularly (custom adjustment is necessary)
  • Manage the risks of infection and blood clots; consult a healthcare professional immediately if pain worsens
• Possible complications: Joint contractures, pressure sores, increased risk of osteoporosis and fractures, pain and neuropathy, depression and social isolation

Checklist Before an Outpatient Visit (Items to Bring and Example Questions)

• Items to bring (recommended)
  • List of currently used medications (including prescription and over-the-counter medications and supplements)
  • Records of previous surgeries and hospitalizations and medical certificates (copies if possible)
  • Recent test results (imaging, blood tests, electromyography, etc.)
  • Records of use and device information for orthoses, wheelchairs, prosthetic hands and legs, etc.
  • Record of symptom changes (when and in what situations symptoms worsen or improve)
  • Limitations in daily life (eating, hygiene, mobility, etc.) and rehabilitation goals
• Information that is useful to submit or explain to the doctor during an outpatient visit
  • When symptoms began and how they have progressed (whether they began suddenly or worsened gradually)
  • Characteristics of the pain (location, intensity, triggers, and whether there is nighttime pain)
  • Duration of orthosis use and discomfort, current means of mobility, and the degree of assistance needed

Examples of General Questions to Ask the Doctor

• What are the expected effects and side effects of this treatment (medication/surgery/orthosis)?
• Given my current condition, what are the treatment goals and the expected prognosis?
• Are there any activities or restrictions that require particular caution in daily life?
• How often and for how long is rehabilitation (physical and occupational therapy) recommended?
• What precautions should I take to prevent complications such as pressure sores and blood clots?

Examples of Condition-Specific Questions

• Regarding disability registration and assessment: “When will the reassessment take place (for example, after 2 years), and can I apply for a disability grade based on my current condition?”
• Regarding orthoses and prostheses: “What type of assistive device (prosthetic leg/hand/orthosis) is most suitable for my current condition, and when should it be custom-made (or how often should it be readjusted)?”